O18 Causes and impact of incomplete reperfusion in eTICI 2b: insights from the ESCAPE-NA1 trial
Bibliographic record
Abstract
Introduction The degree of mTICI 2b reperfusion varies from 51%-89% in acute stroke patients treated with mechanical thrombectomy(MT)1. Incomplete reperfusion could be due to either focal occlusion (residual thrombus, fragmented/migrated thrombus) or slow flow2. With advancing endovascular techniques, residual distal/medium vessel occlusions can be targets for MT or intra-arterial thrombolysis2,3. Aim We investigated the causes of IR and evaluated whether they could be a target for MT. Secondarily, we assessed the proportion of incomplete reperfusion leading to infarction on follow-up imaging. Methods Patients from the ESCAPE-NA1 trial with final mTICI 2b were included. Residual occlusions were evaluated on the final DSA run. The potential targets for MT were assessed as follows: a) single MT-accessible occlusion, b) single MT-accessible occlusion+multiple small non-MT-accessible occlusions, c) single non-MT-accessible occlusion, d) multiple small/non-MT-accessible occlusions or slow flow. Infarction in the incomplete reperfusion territory was assessed on follow-up CT/MR. Results Of 1105 patients in ESCAPE-NA1,443(40.1%) were included with a median of 1 MT pass (IQR1–2). A single MT-accessible occlusion was found in 61/443 cases (13.8%), a single MT-accessible occlusion + multiple small non-MT-accessible occlusions in 86/443(19.4%), a single non-MT-accessible occlusion in 36/443(8.1%), and multiple small non-MT-accessible occlusions or slow flow in 260/443 cases (58.7%). Overall, incomplete reperfusion was associated with infarction in 238/443 cases (53.7%), no infarction in 104/443(23.5%) and impact of incomplete reperfusion was undetermined in 101 cases (22.8%) due to large underlying M1-MCA infarct. Conclusion Incomplete reperfusion was most often caused by multiple small non-MT-accessible occlusions and was associated with development of infarct on follow-up imaging in more than half of the patients. References Tung EL, Mctaggart RA, Baird GL, et al. Rethinking Thrombolysis in Cerebral Infarction 2b: which Thrombolysis in Cerebral Infarction Scales Best Define Near Complete Recanalization in the Modern Thrombectomy Era? Stroke; A Journal of Cerebral Circulation 2017;48(9):2488–93. Kaesmacher J, Ospel JM, Meinel TR, et al. Thrombolysis in Cerebral Infarction 2b Reperfusions: To Treat or to Stop? Stroke 3461–3471. Goyal M, Ospel JM, Menon BK, Hill MD. Mevo: The Next Frontier? J Neurointerv Surg. 2020;12(6):545–547 Do you have any conflict of interest to declare?: No
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".